Provider Demographics
NPI:1992727713
Name:DIAZ, PORFIRIO ERNESTO (MD)
Entity type:Individual
Prefix:DR
First Name:PORFIRIO
Middle Name:ERNESTO
Last Name:DIAZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:#1021 GENERAL DEL VALLE URB. DELICIAS
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00924-3722
Mailing Address - Country:US
Mailing Address - Phone:787-731-2123
Mailing Address - Fax:
Practice Address - Street 1:#1021 GENERAL DEL VALLE URB. DELICIAS
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00924-3722
Practice Address - Country:US
Practice Address - Phone:787-731-2123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6921207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease